Cabergoline and Heart murmur

Anybody knows if Cabergoline can be a problem for cats with heart murmur? Supposedly my Micio is stage 2-3 based on last October checkup.
What's the usual Cabergoline starting dose?
I'm taking Micio to a new vet tomorrow and I'm trying to gather as much info as I can 'cause I don't think the Dr. never dealt with an acrocat before...
Thanks

 

I answered your question about cabergoline dose in post two of the your previous thread here.

Has Micio ever had an echocardiogram to determine the cause of the heart murmur? It's fairly common in older cats, often just caused by aging heart.

 

They must have meant a grade 2 or 3 heart murmur? If he’s not had an ultrasound of his heart, then they don’t know the reason/ source of the murmur? As Wendy said, heart murmurs are reasonably common in older cats. There is no reason that I am aware of to not use Cabergoline, at a starting dose of 10 micrograms per kg of body weight, in a cat with a heart murmur. @Wendy&Neko wouldn’t you say that Acromegaly itself can be quite hard on the heart and the kidneys?

 

Yes, the growth hormone can caused enlarged organs. Hypertrophic cardiomyopathy (enlarged heart) is quite common in acros. Kidney issues are also common.

 

Sorry, forgot I already asked you that. Yes, last oct he had a echocardiogram and only thing vet told me was Micio still have 2-3 grade hm and no need for meds yet.

 

You should have asked for the written report. It will talk about the various chambers of the heart and their size/ thicknesses, etc.

 

Yes, grade 2-3. He had an echocardiogram last october but I did not personally talked to cardiologist (I had to drop off Micio at my vet, some techs from cardiologist clinic came to perform the echo, cardiologist Dr. reviewed it and pass the info to my vet). My vet only told me Micio's hm didn't progress much and still doesn't need medication. Taking those results and other records to the new vet tomorrow morning, hopefully I'll get better/more answers from him.

 

I have it, not sure I fully understand the whole thing

 

Oh. I would like to see it. But anyway, is the diagnosis Hypertrophic Cardiomyopathy? Best wishes for a successful vet visit today!

 

Thank you, will et you know what this new vet will say..
Here's the report:
"Clinical information provided: Progressively louder heart murmur; lethargy; early diabetes; cardiomegaly. 9/21/21 Alb=4.6 (3.9); BUN=50 (36); Glucose=301 (170);Neutro=8588 (8500); Renal Tech Prediction=Positive; T4 normal @ 2.2; Fructosamine=417 (373). ECG interpretation: Sinus rhythm with no criteria for chamber enlargement. Thoracic radiographic interpretation: Three view orthogonal projections provided for review. There is evidence of mild, generalized cardiomegaly. The pulmonary vasculature is normal. The pulmonary parenchyma exhibits a mild, diffuse bronchointerstitial pattern however no cardiogenic edema. The pleural space is normal. Echocardiogram summary: Multiple 2-dimensional, M-mode, and color/spectral Doppler images provided for review. There is mild, diffuse left ventricular wall thickening. The mitral valve appears normal, however there is mild systolic anterior motion (SAM) with mild left ventricular outflow turbulence however no distinct mitral regurgitation appreciated. The left atrium is normal in size with no thrombi/clots or spontaneous contrast. The aortic valve and visible aorta appear normal. The tricuspid valve is normal and no tricuspid regurgitation observed. The right heart chambers are normal in size. The pulmonic valve and visible pulmonary artery appear normal however mild systolic right ventricular outflow turbulence is also present. There is no evidence of pericardial effusion, pleural effusion, or cardiac associated masses on the images provided. Assessment and recommendations: The echocardiogram demonstrates mild left ventricular hypertrophy/thickening with systolic anterior motion of the mitral valve (SAM), and outflow turbulence. These findings can occur due to various causes including hypertrophic cardiomyopathy (HCM), systemic hypertension, and hyperthyroidism. Micio’s thyroid level was reported to be normal. If not yet performed, measurement of his systemic blood pressure is also advised. In the absence of these influences, a diagnosis of left ventricular thickening due to HCM is inferred. Regardless of the cause, left ventricular thickening can result in myocardial dysfunction and ultimately congestive heart failure (CHF) and/or other complications such as thromboembolic disease. Given the mild nature of Micio’s left ventricular thickening and normal atrial size, such impending complications are not expected and no cardiac-specific medications are indicated. Hypertension should be treated, if recognized. Continued diagnostics and treatment for his reported diabetes should also be performed as clinically warranted. Otherwise, at-home monitoring and periodic recheck evaluations are advised. Symptoms of significant progression include difficulty breathing, collapse, coughing, abdominal distention, and the inability to use the limbs (suggestive of a thromboembolic event). Unless the above symptoms or other concerns for progressive heart disease are noted sooner, a recheck cardiac evaluation is advised in 6-12 months."

 

Make sure to get a blood pressure check today. At home, you should count how many breaths per minute that Micio usually takes. Count for 30 seconds and then double it. Hopefully, it’s below 30. Try to count when Micio is asleep or very calm and still. This will give you a good baseline so you will know if there are any increases. Sorry if you already do this.

 

By the way, I have been wondering if you pronounce Micio with an s sound or with the ch sound (more in the Latin or Italian manner.) I have a background in Latin so I want to say it like Me-chee-o instead of Me-see-o. But what is the correct way?

 

Thanks for the suggestions! Just got back from vet app. , really like the Dr. and the fact he's willing to let me try Cabergoline although he clearly told me he's found some contrasting medical research studies ....Sorry for keep asking, WHERE SHOULD I TRY TO GET CABERGOLINE FROM? DO I GET IT FROM AN APOTHECARY OR IS THERE A NORMAL PHARMACY THAT MAY HAVE IT IN STOCK? (have been caught with tons of stuff lately and little time left to do all the researches I should on my own about this...in the middle of saving a trapped squirrel right now
BTW, MICIO stands for kitty cat in Italian (I am Italian) and you are correct, you can say Mee-chee-o

 

I had my Cabergoline compounded by Wedgewood pharmacy. It’s a liquid. I got fish flavor but they have many flavors (including the somewhat popular bacon marshmallow… which sounds like a weird combo.)

 

My Micio is 6.48 KG (lb. 14.3 ), so would I need 64.8 Micrograms of Cabergoline per day, correct? Does it have to be compounded to liquid or can it be powder inside a gel cap (better option for me to give)? Trying to figure this out before I call pharmacies, thank you
P.S.: Micio's Blood Pressure today was 172/107. Dr. was kind of concerned about proteinuria from last blood work on February; he suggested a complete bloodwork check up along with echocardiogram in early June.

 

Yes. That would be correct, although I doubt you will get it exactly 64.8 mcg. I've never known anybody to use pills (I think someone did though? @Wendy&Neko will probably remember.) The liquid is much easier to make dose adjustments if you decide you need to change the dose (let's say Micio loses weight, for example ... HOPE NOT!) I had mine compounded into the liquid, as I said, at a strength of 200 mcg per ml. That way, it was a very small volume of liquid that I squirted in daily.... only .4 ml which isn't much at all. I never had any problem giving it, but Darcy was a sweet lamb and never complained. I am sure that a pharmacy would be able to make capsules. It would be good to find out how large the capsules would be (capsule size number) and the cost as compared to liquid. Just a few thoughts.

 

Thank you very much, that helps a lot. Will let my vet know about it.

 

Cabergoline was after my time, so I don't remember what formulations people used. I'd have to read through some of the longer cabergoline threads on this forum, but you can do that too. I thought most used liquid. As Suzanne said, easier to adjust dosing if needed. I found liquid easier to give Neko as well. Not sure if some people just put it on the food too.

With his last urine protein creatinine ratio in the labs at 1.6, I'm surprised the vet hasn't started him on something for that yet. Anything over 0.5 should be addressed. It's harmful for the kidneys to stay in higher numbers. That BP is also a little on the high side. BP can be elevated at the vet - Neko has some really high numbers the first couple times, but it did settle down in the right environment.

 

I agree with Suzanne too, liquid can also be dosed accordingly.
About the protein creatinine ratio, what can possibly be given to lower that number?
Reason number one why I switched to a different vet as soon as I found one...old vet was never worried about those high values as I was. Today it was the first visit with new vet and lots of things to discuss but I'll call tomorrow and ask about the urine protein creatinine ratio.

 

Tanya's page on proteinuria: http://www.felinecrf.org/proteinuria.htm.
Neko was on benazapril for her proteinuria. Telmisartan is a new drug also used now. More details on the site I've linked.

 

I get mine from Wedgewood and concentration is 300mcg/ml. That is 10mcg/kg for my 17 lb Snuffles and results in giving 0.25ml. I just add it it his food. At least one person uses capsules since they discussed either hereon in the FB group doubling the dose since they used capsules.

 

Benazepril can be given to lower the protein

 

Oh perfect … I scrolled up and see that Wendy linked the page about protein in the urine and treatments for it. Saves me the trouble. Excellent information there!

 

On Wedgewood Pharmacy website they list Cabergoline compounded into "Oral Oil Suspension", is this one you guys get?

 

Yes, that is what Snuffles gets. He gets the bacon-marshmallow flavor. I add it to his food.

 

Yes. That’s the one.

 

I saw "Oil based" and want to make sure, Thank you very much. Btw, Micio's breaths per minute are 24-26

Thank you Larry.

 

I believe it is almond oil based. Great breaths per minute! Now you have a baseline number!

 

Th

Thank you. I think Telmisartan oral solution is equivalent to Semintra (sold also on Chewy)

 

Yes, Semintra is the brand name. See what the vet says, some might prefer one vs the other. When Neko got her heart condition, the benazapril was helpful for that too.

 

I just got a prescription for Benazepril HCL 5 Mg tablet and it says "Give one half tablet by mouth every 12 hours (1 tab per day)", is that about the right dosage to begin with? Just confirming with you guys since you use it...
Tnx

 

Vet wanted to start with Benazepril 5 Mg per day; said Semintra can possibly be added later on

 

That’s the exact dose of Benazepril Hydrochloride that my cat Ginger gets. One half of a 5 mg tablet daily — she does not get it twice a day. She was started on this dose for mild left ventricular thickening - HCM. Diagnosed via ultrasound.

 

Ok, thanks. Sometimes this week I should receive Cabergoline too: can this 2 meds be given together or separate? I could add Benazepril with insulin at 6am and 6pm and give Cabergoline at lunch along with Ursodiol...do you think it sounds OK? Dr. did not advise of any interaction between meds but I trust your judgment best

 

If I were worried about it, I would separate them by a few hours. One reason would be in case of a stomach upset and vomiting, then he wouldn’t lose the Benazepril as well as the Cabergoline. I think your plan sounds like a good one - you won’t have to overwhelm him with medication all at once.